Postoperative wound care protocol prevents surgical site infection after craniotomy

Abstract

Background: Postoperative wound care after craniotomy is not standardized.

Objective: Evaluate the impact of a standardized post-craniotomy wound care protocol on surgical site infection (SSI).

Design and setting: Prospective quasi-experimental single-center intervention cohort study involving adult patients undergoing craniotomy at a 461-bed academic medical center in Orange County, California from January 2019-March 2023 (intervention) compared to January 2017-December 2018 (baseline).

Methods: A postoperative neurosurgical wound care protocol was developed involving chlorhexidine cloths to remove incisional clots and to clean the surgical incision and adjacent hair after craniotomy surgery. Protocol adherence was monitored by routine inpatient surveillance of wounds and photo-documentation for real-time feedback to surgeons and nursing staff. Impact of the intervention was assessed using multivariable regression models.

Results: There were 3560 craniotomy surgeries and 62 (1.7%) SSIs; 1251 surgeries and 30 (2.4%) SSIs during baseline, and 2309 surgeries and 32 (1.4%) SSIs during intervention. Process evaluation after implementation found significant decreases in incisional clots, erythema, drainage, and unclean hair. In multivariable analysis, the intervention was associated with fewer SSI (odds ratio (OR): 0.5 (0.3, 0.9), P = 0.02).

Conclusions: A standardized post-craniotomy wound care protocol involving cleaning of the incision and adjacent hair, including removal of incisional clots with chlorhexidine cloths was effective in reducing the risk of SSI.